title: Self-concept and quality of object relations as predictors of outcome in short- and long-term psychotherapy.
abstract: BACKGROUND
  Quality of object relations and self-concept reflect clinically relevant aspects of personality functioning, but their prediction as suitability factors for psychotherapies of different lengths has not been compared. This study compared their prediction on psychiatric symptoms and work ability in short- and long-term psychotherapy.
  
  
  METHODS
  Altogether 326 patients, 20-46 years of age, with mood and/or anxiety disorder, were randomized to short-term (solution-focused or short-term psychodynamic) psychotherapy and long-term psychodynamic psychotherapy. The Quality of Object Relations Scale (QORS) and the Structural Analysis of Social Behavior (SASB) self-concept questionnaire were measured at baseline, and their prediction on outcome during the 3-year follow-up was assessed by the Symptom Check List Global Severity Index and the Anxiety Scale, the Beck Depression Inventory and by the Work Ability Index, Social Adjustment Scale work subscale and the Perceived Psychological Functioning scale.
  
  
  RESULTS
  Negative self-concept strongly and self-controlling characteristics modestly predicted better 3-year outcomes in long-term therapy, after faster early gains in short-term therapy. Patients with a more positive or self-emancipating self-concept, or more mature object relations, experienced more extensive benefits after long-term psychotherapy.
  
  
  CONCLUSIONS
  The importance of length vs. long-term therapy technique on the differences found is not known.
  
  
  CONCLUSIONS
  Patients with mild to moderate personality pathology, indicated by poor self-concept, seem to benefit more from long-term than short-term psychotherapy, in reducing risk of depression. Long-term therapy may also be indicated for patients with relatively good psychological functioning. More research is needed on the relative importance of these characteristics in comparison with other patient-related factors.
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland. Electronic address: olavi.lindfors@thl.fi.
authors.forename: Olavi
authors.initials: O
authors.lastname: Lindfors
authors.forename: Paul
authors.initials: P
authors.lastname: Knekt
authors.forename: Erkki
authors.initials: E
authors.lastname: Heinonen
authors.forename: Esa
authors.initials: E
authors.lastname: Virtala
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology / Q000628:therapy*; D009769:Object Attachment; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief; D064889:Psychotherapy, Psychodynamic; D012649:Self Concept; D012919:Social Behavior; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: Long-term; Object relations; Outcome; Psychotherapy; Self-concept; Short-term